Lumps In the Neck
Many children have small lymph nodes in the neck which increase in size with colds and sore throats. They may be tender during the illness but settle back down in size when the child gets better.
There are a number of cysts of the neck that can occur from birth. Cysts can be seen on an ultrasound which is harmless and similar to an antenatal scan.
Thyroglossal cysts
These are quite common lumps in the front of the neck. They are usually just to the left of the midline or in the midline and vary in size from a pea to a tangerine.
These usually originate along the embryonic route of the thyroid as it makes its way from the back of the tongue to lie in the bottom of the front of the neck.. The cyst often has some of the duct (tube) attached and this is important as unless this duct is removed as well as the cyst, the lump will come back.
The correct operation is named a Sistrunk's operation and aims to remove the cyst and any of the duct in one block. One key step is to remove the central part of the hyoid bone as the duct can lie behind it. The block is then extended up into the base of the tongue.
Recurrent thyro-glossal cysts require a further block excision of the lump surrounded by a cuff of normal tissue.
Branchial cysts
These are usually 1/3 way up the big muscle in the neck from the breastbone to behind the ear. They tend to be the size of a small egg and also get infected. Again expert removal is usually indicated.
Dermoid cysts
These are skin cysts which can occur in the neck.
Lymph nodes
Single large lymph nodes can occur on the side of the neck in association with recurrent tonsillitis or specific infections.
Lymph glands in the neck always concern parents because of the fear of lymphoma, a tumour of the lymph glands. This presents with rubbery nodes which continue to increase in size and distribution. If they do not respond to antibiotics a biopsy may be occasionally be appropriate. Fortunately most nodes are harmless and reassurance is all that is needed.
Pre-auricular Sinus
These are congenital holes in front of the ear. Once infected they can leave a small lump. It is important to remove them with a wide margin to avoid recurence